Background/objectives
Expert oral anticoagulation management is the key to good outcomes and is performed variably in different health care systems
throughout the world. We set out to assess the quality of anticoagulation management in five countries in patients receiving
vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the
anticoagulation management practices in these countries.
Methods and results
This was a retrospective, multi-centre cohort study in the United States, Canada, France, Italy, and Spain. About 1,511 patients
were randomly recruited from representative practices (routine medical care (RMC) in the US, Canada, and France; anticoagulation
clinics in Italy and Spain) and data pertaining to their oral anticoagulation care were abstracted from their medical records.
The predominant anticoagulant in use was warfarin in the US, Canada, and Italy; acenocoumarol in Spain; and fluindione in
France. Documentation of care was poor in the US, Canada, and France, countries where RMC was studied. Percent INRs or time-in-therapeutic
range was greater in the two anticoagulation clinic samples compared with the RMC samples.
Conclusion
Oral anticoagulation care varies considerably from country to country. Findings suggest that anticoagulation clinic care (ACC)
may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat
more than over treat. Finally, documentation of care is often inadequate.
Condensed Abstract Oral anticoagulation management (routine medical care or anticoagulation clinic care) was retrospectively assessed in 5 countries
using a uniform, structured assessment tool. Major management differences were detected, especially between anticoagulation
clinic care and routine care. Documentation was often a problem in the latter setting. Less time in therapeutic INR range
was noted in routine medical care. Findings suggest that anticoagulation clinic care may provide better outcomes as assessed
by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation
of care is often inadequate.
Keywords Oral anticoagulation - Warfarin - International normalized ratio - Atrial fibrillation
This study was presented in part at the 8th National Conference on Anticoagulant Therapy, Orlando, Fl, May 2005, sponsored
by the Anticoagulation Forum. This study was supported by a grant from AstraZeneca, Molndal, Sweden.